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					North Sydney Futsal                                      2011/12 Registration Sheet

Team Details                                                                                    Our Contact Details
                       Night                                                                                                  North Sydney Futsal
                     Division                                                                                                 Futsal Competitions
                  Team Name
                 Team Colour                                                                                            Contact: Sasha Ellis
                Team Contact                                                                                             Ph: 0410 400 601
                       Email                                                                               E: admin@northsydneyfutsal.com

Player Details -                   Only player names appear on match sheets, Full details are needed for insurance purposes
No.            Name                Address                                                      Mobile                        DoB
1
2
3
4
5
6
7
8
9
10
11
12
     additional or updated team player details may be submitted by 19/8/2011
Payment Details- Please check our website for team fees
1. Credit Card Payment
                Card Number                                                    Billing Schedule
                       Expiry                                       Deposit due today
                  CardHolder                                        Balance due 8/8/11
2. Direct Deposit- Electronic Banking or deposit at a branch
                         Bank                  St George            Deposit due today
                       Name               North Sydney Futsal       Balance due 8/8/11
                          BSB                   112 879
                     Account                  455 921 236
                          Ref          Your or your team name
       Please email admin@northsydneyfutsal.com as well when making a Direct Deposit
3. BPAY - Please request an invoice via email

Important Notes
     A deposit ($200) and or the balance must accompany the teams registration
     Please enter whether you want to pay the entire amount or a deposit and balance.
     Deposits are non refundable if you don't wish to proceed with entering a team
     Please see www.northsydneyfutsal.com for terms & conditions

      There is a maximum of 12 players per team in any one competition




                                                             www.northsydneyfutsal.com

				
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